Today, tracheotomy is one of the more commonly performed procedures in otolaryngology and head and neck surgery.
Currently, a tracheotomy is performed for a variety of indications. The most common of these is airway obstruction, which can be either acute or chronic. Acute airway obstruction may be due to an infectious process, or any deep neck space infection.
Chronic airway obstruction is usually due to the presence of a mass, sometimes benign but most often malignant.
Tracheotomy may be done either at a patient's bedside, such as in an intensive care setting, or in the operating room. A midline skin incision is made from cricoid cartilage almost down to the jugulum. The trachea is then entered sharply, usually at the second or third ring. The orotracheal tube (if present) is withdrawn, and the airway is secured with the tracheotomy tube.
There are typically three parts to a traditional tracheotomy tube: an outer tube, an inner tube, and a stylet or obturator. A stylet or obturator is used to introduce the tube into the trachea. The stylet fills the end of the outer tube and provides a tapered point so that the advancing end does not tear tissue. Once the tube is in place, the stylet is withdrawn immediately, because while it is in place, there is no airway. The inner cannula is then inserted and locked in place. Gauze tapes previously attached to the outer tube are tied around the neck.
After the operation, the outer tube stays in the trachea until the surgeon believes it is safe to remove it for cleansing and inspection of the wound. Ordinarily, the nurse does not remove the outer tube unless specifically instructed by the physician because there is sometimes difficulty in replacing it. The mistake is to insert the tube into the soft tissue of the neck other than into the lumen of the trachea.
The inner tube is the province of the nurse. This tube fits the inside of the outer tube snugly, yet loosely enough that it can be removed by light finger traction.
In the immediate postoperative period, the inner tube should be removed, inspected and cleaned every two hours. If it is not done, small amounts of dried blood may cause difficulty in removing the cannula. It is by cleansing the inner tube that the airway is maintained. Cleaning is needed more often in a patient whose chest is filled with secretion than in a patient with laryngeal obstruction but no excessive secretions.
In a patient whose chest is filled with secretions, suctioning must be done frequently--as often as every five minutes. In other patients, suctioning every two or three hours or even once or twice a day may be all that is necessary. In suctioning, the aim is to aspirate all secretions that have accumulated in the tracheobronchial tree since the last suctioning and which the patient is unable to cough up himself.
Patients may develop obstructive plugs of dried mucus in the trachea that actually endanger his airway unless the tracheotomy tube is removed and the plug pulled out.
If the tube is coughed out, it is usually because the ties were not sufficiently tight or because the tube was too short. This can amount to an emergency if it occurs in the first few hours after tracheotomy, because a sufficient tract has not yet been formed between skin and trachea to sustain breathing. The tube must be reinserted at once.
To date, there are no devices to monitor the patency of tracheotomy tube. The present invention alerts the hospital staff to a clogged or dislodged tube.